From the editors of Review of Ophthalmology:
In this issue: (click heading to view article)
Systemic Corticosteroid Use After CSC Diagnosis
Researchers analyzed the frequency of systemic corticosteroid prescriptions before and after central serous chorioretinopathy diagnosis, as part of a retrospective claims-based analysis.
Participants included a nationally representative sample of commercial insurance beneficiaries who received care between 2007 and 2015. Researchers limited the study population to beneficiaries with incident CSC diagnosed by an eye-care provider, excluding those with other major ophthalmologic comorbidities.
They developed a non-CSC comparison cohort matched to CSC patients on age, sex, general health (Charlson Comorbidity Index) and geographic region. They compared systemic corticosteroid prescriptions before and after CSC diagnosis, and by provider type (optometrist vs. ophthalmologist). Researchers also evaluated the likelihood of receiving steroids among CSC patients vs. matched controls, using logistic and Cox proportional hazard regression models.
Main outcome measures included: frequency of systemic corticosteroid prescriptions among CSC patients within 12 months pre-diagnosis, and at six, 12 and 24 months post-diagnosis; median time to steroid initiation and discontinuation; and odds of receiving post-diagnosis steroids among CSC patients and controls.
Researchers identified 3,418 CSC patients. Here were some of the findings:
- Nearly 39 percent (n=1,326) were prescribed systemic steroids at some point during the analysis period, compared with 23 percent of matched controls (4,033 of 17,178 patients).
- More than 12 percent of CSC patients (n=430) received steroids within a year pre-diagnosis, and nearly 12 percent (n=404) received steroids within one year post-diagnosis.
- Most patients who received post-diagnosis steroids were steroid-naïve (n=231).
- The most common steroid prescribed was oral prednisone (an approximately one-month supply).
- Among those receiving steroids, CSC patients had longer median time to first post-diagnosis steroid prescription (1.82 years vs. 0.50 year for controls) and longer time to last steroid prescription (1.62 years vs. 0.35 year for non-CSC patients).
- Although CSC patients were significantly less likely to receive steroids at six months post-diagnosis compared with matched non-CSC patients (OR=0.72; CI, 0.59 to 0.89), they were significantly more likely to receive steroids by two years post-diagnosis.
- Prescribing patterns were similar for patients diagnosed by an ophthalmologist vs. optometrist.
Scientists found that, despite evidence showing steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis. They added that their results suggest a need for greater communication and collaboration among providers to ensure clinical practice reflects evidence-based recommendations.
Source: Azad AD, Zhou M, Afshar AR, et al. Systemic corticosteroid use after central serous chorioretinopathy diagnosis. Ophthalmology 2020; June 30. [Epub ahead of print].
Complimentary CME Education Videos
Rotational Slit-beam Marking: A Corneal Astigmatic Marking Method for Toric IOL Implantation
Researchers evaluated the accuracy of an advanced manual corneal astigmatic marking method for toric intraocular lens implantation. A total of 52 patients (52 eyes) with cataracts and corneal astigmatism were included.
The target axis of the toric IOL was marked with the new manual marking method preoperatively and with the Zeiss Callisto Eye image-guided system intraoperatively. For the manual method, a slit lamp with a minimum rotation angle of five degrees was used, and rotated to the meridian of the toric IOL and incision axes. Researchers measured the relative rotational and vertical deviation of the IOL and incision axes using the digital marker as a reference.
Here were some of the findings:
- Researchers found no significant difference between the manually marked IOL axis (100.9 ±65.62 degrees) and the digital mark (100.8 ±65.76 degrees; p=0.771).
- The absolute values of the relative rotational deviation (2.03 ±1.44 degrees) and vertical deviation (0.46 ±0.43 mm) of the manually marked IOL axis were small.
- Researchers found no significant difference between the manually marked corneal incision and the digital meridian (p=0.179).
- In patients classified into three groups based on the type of astigmatism they had, researchers found no significant difference in mean absolute deviation among the groups (p=0.112).
- The manual incision mark had a relative rotational deviation of 1.65 ±1.44 degrees.
- The vertical misalignment of the manually marked incision axis was 0.27 ±0.30 mm.
Researchers concluded that rotational slit-beam marking could be an effective and convenient marking method for toric IOL implantation and could serve as a potential alternative in underdeveloped areas where digital image-guided systems aren’t available.
SOURCE: Wu Q, Liu Y, Cai H, et al. Rotational slit-beam marking: An advanced manual corneal astigmatic marking method for toric intraocular lens implantation Int Ophthalmol 2020; July 4. [Epub ahead of print].
Complimentary CME Education Videos
Novel Method for Averaging OCTA Images
Investigators developed a method of averaging optical coherence tomography angiography images to improve visualization of choriocapillaris structure.
They placed a stack of OCT angiographic data from vascular layers into the red-green-blue channels of a conventional digital color image. And they placed the superficial plexus in the blue channel, choriocapillaris in the green and deep vascular plexus in the red channel. The investigators registered the red-green-blue images derived from nine separate OCTA scans using an automatic registration sequence, and averaged the images. The averaged red-green-blue image was then split into the three averaged component layers. The flexible technique can use any vascular layer, such as macular neovascularization.
The utility of the imaging method was demonstrated by the imaging of two different diseases:
- One patient had a history of familial amyloidosis, hypertension, kidney failure, kidney transplantation and prednisone use, followed by central serous chorioretinopathy, which was treated by photodynamic therapy. She had alterations in retinal pigment epithelial pigmentation and widespread abnormalities of autofluorescence. She showed remarkably decreased vascular density and vessel configuration of the choriocapillaris.
- Another patient with pseudoxanthoma elasticum with subretinal drusenoid deposits at an early age also showed marked decreased choriocapillaris density and vascular configuration. These findings were compared with healthy controls of a similar age with no abnormalities.
Investigators wrote that the detailed method was capable of averaging choriocapillaris OCT angiographic images using a simple automatic method. They added that image averaging offers an opportunity to improve noisy OCTA images so that the vascular structure is visible.
SOURCE: Spaide RF, Ledesma-Gil G. Novel method for image averaging of optical coherence tomography angiography images. Retina 2020; Jun 26. [Epub ahead of print].
Combined Phacoemulsification with Goniosynechialysis for PACG after Failed Trabeculectomy
Scientists evaluated the efficacy and safety of combined phacoemulsification with goniosynechialysis under an ophthalmic endoscope (Phaco-OE-GSL) for primary angle-closure glaucoma with cataract after failed trabeculectomy.
A total of 25 patients (25 eyes) were enrolled in the retrospective study. Scientists recorded intraocular pressure, best-corrected visual acuity, and number of glaucoma medications at baseline and each postoperative follow-up visit. They also recorded peripheral anterior synechiae using gonioscopy. Scientists then used binary logistic regression to analyze the risk factors of surgical failure.
Here were some of the findings:
- The mean follow-up duration was 17.9 ±11.4 months.
- The mean IOP was significantly lower than the preoperative baseline IOP at all time points (p<0.001).
- The mean IOP was reduced from 24.4 ±6.5 mmHg at baseline to 14.2 ±3 mmHg at the last follow-up visit.
- The mean preoperative number of glaucoma medications was 2.2 ±1.2, which reduced to 0.9 ±1.1 at the last follow-up visit.
- The complete success rates were: at one-year, 70.6 percent; and at the last follow-up, 68 percent.
- The total success rates were: at one-year, 96 percent; and at the last follow-up, 92 percent.
- The most common postoperative complications were IOP spikes (48 percent) and hyphemas (32 percent).
- All eyes had degrees of PAS recurrence, with a range of 96.1 ±52.50 (30 to 2,100) after four to six months.
- Larger pupil diameter and younger age were significantly associated with the failure of Phaco-OE-GSL.
Scientists wrote that Phaco-OE-GSL appeared to be safe and that it could lower IOP for failed trabeculectomies in PACG with cataract, despite a high recurrence rate of PAS.
SOURCE: Nie L, Fu L, Chan YK, et al. Combined phacoemulsification with goniosynechialysis under ophthalmic endoscope for primary angle-closure glaucoma after failed trabeculectomy. J Glaucoma 2020; June 16. [Epub ahead of print].
Hoster Succeeds Henne as Publisher of the Review Group
Jobson Medical Information announced that Michael Hoster, a 13-year veteran of the company, was named Publisher of the Review Group of publications and services. This includes the titles Review of Optometry, Review of Ophthalmology, Review of Cornea and Contact Lenses and Retina Specialist, as well as a host of affiliated websites, e-newsletters and other digital products designed to provide robust clinical insight and education to optometrists and ophthalmologists. Hoster assumed the position previously held by veteran publisher and industry icon James Henne since 2014. “Mike has been an instrumental player at the Review Group for 13 years, playing key roles on our editorial and sales teams,” said Marc Ferrara, president of Jobson’s Optical Group. “Of course, we will all miss Jim Henne, who has done an outstanding job leading the Review Group. Jim's insights, leadership skills and witty charm make him a very unique leader.” Hoster has spent his entire professional career at Jobson, beginning as an associate editor for Review of Optometry in 2007. He also served as the magazine’s managing editor from 2012 through 2014. Hoster later transitioned to the Review Group’s sales team in 2015, “Mike has become an extremely valuable team member over this period, and has developed a keen understanding of the markets we serve and the products we deliver,” added Ferrara. “The Review Group has a sterling reputation for providing the most cutting-edge, clinically relevant information available to the eye-care community,” said Hoster. “Jim has been an invaluable leader to our group, a consummate mentor to me and a true inspiration to our entire company. I look forward to following in his footsteps, and working with our team in an effort to serve the needs of our readers and industry partners.” Read more.
GRF Survey Reveals Glaucoma Patients' Concerns During COVID-19
The Glaucoma Research Foundation announced results from a survey— conducted among patients in the GRF database and supported by Aerie Pharmaceuticals—that revealed glaucoma patients’ concerns during the COVID-19 pandemic shutdowns. A total of 1,051 adult glaucoma patients from 49 states responded to the online National COVID-19 Glaucoma Impact Survey over four days in May 2020. Findings suggest that about one-third of glaucoma patients weren’t confident their disease was well-managed during the initial months of the pandemic (36 percent reportedly were “somewhat confident” or “not confident”). Confidence level wasn’t associated with patients’ age, gender or geography, but was by appointment status. More than half of patients surveyed reported having to delay and/or cancel a glaucoma appointment during the first months of the pandemic. Read more.
Ocular Therapeutix Announces First Published Physician Fee Schedule for Intracanalicular Inserts
Ocular Therapeutix announced that Novitas Solutions, one of seven Medicare Administrative Contractors (MACs), became the first MAC to establish a physician fee schedule for procedure code 0356T for the administration of drug-eluting intracanalicular inserts, including Dextenza (dexamethasone ophthalmic insert) 0.4 mg, effective July 1. The professional fee for CPT code 0356T is now eligible to be paid per the established local fee schedule, which can be found on the Novitas website. Novitas covers Medicare patients in 10 states, including New Mexico, Texas, Colorado, Oklahoma, Arkansas, Louisiana, Mississippi, New Jersey, Pennsylvania, Delaware and the District of Columbia. Read more.
Alimera Initiates Trial to Evaluate Iluvien as Baseline DME Therapy
Alimera Sciences initiated the company’s NEW DAY clinical trial, a randomized, controlled, multicenter study designed to generate prospective data for Iluvien (fluocinolone acetonide intravitreal implant) 0.19 mg as a baseline therapy in patients diagnosed with diabetic macular edema. The trial, which was also intended to demonstrate the therapy’s advantage over repeat anti-VEGF injections, is expected to enroll 320 treatment-naïve, or almost naïve, DME patients in approximately 42 sites around the United states. Read more.
ImprimisRx Touts Combination Drop Study
ImprimisRx announced that a randomized contralateral eye study published in the open-access journal Clinical Ophthalmology comparing patient outcomes and preferences for a combination therapy with individual eye-drop medications after ocular surgery revealed that ImprimisRx’ combination drop showed similar health outcomes to multiple separately dosed drops. (One of the authors is an Imprimis consultant and another received grant support from Imprimis during the study.) The combination drop also was unanimously preferred by patients as it was easier to manage, the company says. Read more.
MeiraGTx Shares Data on RP Treatment
MeiraGTx Holdings, a clinical-stage gene therapy company, recently announced six-month data from the ongoing Phase 1/2 clinical trial (Trial number: NCT03252847) of AAV-RPGR, an investigational gene therapy in development for the treatment of patients with X-linked retinitis pigmentosa with genetically confirmed variants in the RPGR gene. The company says significant improvement in vision was demonstrated in the dose escalation phase of the trial, and that AAV-RPGR was found to be “generally well tolerated.” These initial results from the trial are being presented as a late-breaker oral presentation at the American Society of Retina Specialists 2020 Virtual Annual Meeting.
MeiraGTx and Janssen Pharmaceuticals, one of the Janssen Pharmaceutical Companies of Johnson & Johnson, are jointly developing AAV-RPGR as part of a broader collaboration to develop and commercialize gene therapies for the treatment of inherited retinal diseases. Read more.
Prevent Blindness Holds Virtual Summit Meeting
Prevent Blindness, the nation’s oldest volunteer eye health and safety organization, held its 9th annual Prevent Blindness Focus on Eye Health National Summit as a virtual event on July 15, 2020. This year’s Summit included a variety of presentations and discussions related to the theme, "An Eye to the Future.” Copies of presentations and webinar recordings are available here.
Personnel Briefs from Around Ophthalmology
Several companies added to their ranks in recent weeks:
• EyePoint Pharmaceuticals appointed Jay S. Duker, MD, as chief strategic scientific officer—a newly created role—to advance research and development efforts for lead its development candidate EYP-1901 for wet AMD and other diseases. In conjunction with the appointment, Dr. Duker stepped down from the company’s board of directors. He will serve on a part-time basis while continuing his retinal practice and acting as the chair of ophthalmology at Tufts Medical Center and the Tufts University School of Medicine.
• Donald J. Zurbay has been appointed as a member of the Sight Sciences’ Board of Directors. The company says Mr. Zurbay joins with more than 28 years of experience primarily leading finance, accounting and strategy for high-growth medical technology businesses. He currently serves as chief financial officer of Patterson Companies, a leading dental and animal health products company.
• Tarsus Pharmaceuticals appointed Sesha Neervannan, PhD, chief operating officer and Leo Greenstein chief financial officer. Dr. Neervannan most recently served as as a senior vice president of global pharmaceutical development at Allergan. Mr. Greenstein came from Spectrum Pharmaceuticals, where he served as senior vice president of finance and corporate controller.
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